| NPI | 1063535987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CO 054635) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 229553) |
| 207X00000X Orthopaedic Surgery (Licence: TX P0415) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX P0415) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2021-04-07 |